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neupogen and hep c treatment
Sep 23, 2005

Hi Dr. I am currently in my 22wk of tx with pegasy/copegus 1200mg of copegus. I am geno type 1a stage 4 moderate cirrhosis.

My wbc and anc counts have been very low since the 4th wk of treatment. My wbc is currently 1.2 and anc are 300. My wbc have not reach 2.0 since wk 4 of treatment and anc 876. (usually ranging from 300 to 700.

I have requested neupogen to help increase my wbc and anc. My doctors gastro/hep and hematoligist states to me my cts are to low for the neupogen to help. The gastro/hep reduced the copegus to 800mg daily for one wk and prescribed Levaquin for ten days to try and increase wbc and anc. Is this a normal procedure?

My ins states to me they will pay for the neupogen with my wbc and anc being so low. I am really confused why my doctor will not place me on neupogen to assist me with completing treatment, seeing the seriousness of my condtion.

Do you prescribe neupogen to assist your pts in completing treatment of hepatitis c and is it possible my wbc and anc are to low for neupogen to work?

I do realize that the FDA has not approved neupogen associated with hepatitis c treatment, yet I have talked with many many hep c pts that are receiving neupogen to assist them thru treatment.

Very concerned doctors are not doing everything possible to help me complete treatment.

Thanks for your time jhp9

Response from Dr. Dieterich

We use neupogen (Filgastrim) or GCSF all the time! We usually use an ANC of 500 as a guide. It works no matter how low your counts are! There is not a real worry frankly about infection, but levaquin is not going to increase your counts unless you have an infection! We usually use 300 mcg once per week or 150 mcg twice weekly. There is also a pegylated version that is easy to take once per week. Reducing RBV is not going to help either! I don't know what else you can do to persuade your MD. Good luck! The good news is that you are beating the virus! Keep it up! DTD



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